Civil Remedy Notice of Insurer Violations
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Filing Number:     804378
Filing Accepted:  1/30/2025
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Complainant
Last/Business Name *  
AHMAD   First Name   WALAA
Street Address * 245 GEORGETOWN LOOP
City, State Zip * WAUCHULA, FL 33873
Email Address * WILLIEAHMAD@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   AHMAD   First Name   WALAA
Policy # * 1501-1902-6570 Claim #* FL20-0130965
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY
NAIC Company Code 10861
 
Name of individual responsible for violation (if any):* PETER LIST, JOSE CARDOZA, JODI SPILOTRAS, WILLIAM CLEMONS, AND ANY OTHER INDIVIDUAL FROM UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM AND UNKNOWN TO CLAIMANT, AND UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY'S COUN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Other : Not treating the policyholder with good faith claims conduct
Other : Placing the company's financial interests before the policyholder's interests
Other : Looking for ways to deny full recovery to the Insureds
Other : Failing to implement proper standards for the adjustment and investigation of claims
Other : Looking for ways to delay full recovery to the Insureds
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Universal Property & Casualty Insurance Company, ("Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Policy Holder and Claimant; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) failing to implement proper standards for the adjustment and investigation of claims; 6) looking for ways to delay benefit payments; and 7) conducting inadequate investigations. The Claimant timely submitted a claim to the Insurer for the damage sustained to the above referenced insured property as a result of a sudden and accidental AC overflow and ensuing water damage. Due to the extent of the water damage sustained to the garage, kitchen, laundry room, dining room, living room, hallway, and foyer, the Claimant obtained an estimate for $63,308.66. To date, the Insurer has failed to render a written claims determination for the damage sustained to the insured property. Pursuant to Florida Statute 627.70131, the Insurer has ninety (90) days from the date a loss is reported to make a claims determination. The public adjuster, on behalf of the Claimant, reported the claim on August 20, 2020; yet the Insurer has still failed to make any claims determination to date. This has delayed tendering the benefits owed under the insurance policy to the Claimant. The Insurer failed to work in consultation with the Claimant and adjust the loss. This has delayed and frustrated the Claimant's ability to have the claim adjusted promptly to begin restoring the property. The Insurer and its adjustor have colluded to delay the claim and are placing the financial interest of the Insurer over that of the Claimant. In short, the Insurer is not acting with due regard for the Claimant's interests. Although the Insurer and Insured may be in dispute about how the damage was sustained to the insured property, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. Further, this Insurer has a business practice of shifting the burden onto the Claimant to assess the damage sustained to the insured property in order to recover the funds necessary to restore the property to its pre-loss condition. Insurer expects the Claimant to shell out funds for an independent contractor to assess the damage sustained to the property in order to recover what she is rightfully owed, rather than conducting its own adequate and thorough investigations. Insurer requests from the Claimant itemized estimates and invoices, a comparison of Insurer's estimate to Claimant's estimate, receipts, photographs, and a detailed repair estimate pursuant to the policy language to further shift the burden onto the Claimant to investigate their claim and to further frustrate and delay the claim to avoid having to pay to restore Claimant's property to its pre-loss condition, which is Insurer's duty under the contract of insurance issued by it. In short, the Insurer is not acting with due regard for the Claimant's interest. In Florida, the work of adjusting insurance claims engages the public trust. The Insurer has breached this duty. The Insurer has significantly underestimated the replacement costs of Insured's property to further frustrate and delay the Claimant's claim. The Insurer's actions amount to but are not limited to the following: 1. Claim delay 2. Not treating the Policyholder with good faith claims conduct 3. Looking for ways to reduce recovery to the Claimant 4. Looking for ways to deny recovery to the Claimant 5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Claimant 6. Failing to implement proper standards for the adjustment and investigation of claims 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the policyholder's interests 8. Conducting inadequate investigations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1) Admit full coverage for the Insured's loss. (2) Tender full benefits owed to the Insureds under the insurance contract. A copy of this form submitted to the FDFS has been sent via Electronic Mail to the following parties providing them notice of the filing of the civil remedy notice. Please email any response to this civil remedy notice to badfaith@krapflegal.com VIA ClaimPath Portall: Universal Property & Casualty Insurance Company 1110 W Commercial Blvd, Fort Lauderdale, FL 33309
Comments
User Id Date Added Comment
oc1102@universalproperty.com 03-19-2025 March 19, 2025 VIA ELECTRONIC FILING Florida Department of Financial Services Bureau of Consumer Assistance Civil Remedy Section 200 East Gaines Street Tallahassee, FL 32399-0322 Re: DFS File No.: 804378 Filing Date: 1/30/2025 Complainant(s): Walaa Ahmad Insured(s): Walaa Ahmad Policy No.: 1501-1902-6570 Claim No.: FL20-0130965 Dear Sir/Madam: Please allow this to serve as Universal Property & Casualty Insurance Company’s (“Universal”) formal response to the above-referenced Civil Remedy Notice (“Notice”) filed by Attorney, Grant W Krapf, on behalf of Complainant Walaa Ahmad (also referenced as the “Insured.”) The Notice alleges violations of Sections 624.155 and 626.9541, Florida Statutes. Universal denies that it violated these or any statutes, Florida law, or policy provisions regarding the claim adjustment of this matter. With that said, Universal asserts that the Notice fails to comply with the specific notice and information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions, Section 624.155, Florida Statutes and Florida law. Here, the Notice fails to meet the requirements of Section 624.155, Florida Statutes on several grounds. First, the Notice fails to satisfy the requirement to identify the person or persons representing the insurer most responsible for or knowledgeable of the facts giving rise to the allegations. Second, the Notice fails to reference specific policy language relevant to the alleged violation. Third, with respect to the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to allege specific conduct on the part of Universal that would violate any policy provision or statute. Lastly, the Notice fails to provide a proper means by which Universal can cure the alleged defects in the Notice. Therefore, the Notice is insufficient and fails to satisfy the condition precedent to filing a bad faith cause of action. See Pin-Pon Corp. v. Landmark American Ins. Co., 500 F. Supp. 3d 1336 (S.D. Fla. 2020); Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). Notwithstanding the above referenced deficiencies, the parties have reached an amicable resolution of the disputed claim. Throughout the handling of the Insured’s claim, Universal has acted in good faith toward the interests of its Insured. Universal has timely and fairly investigated the reported loss in accordance with Florida law, the policy provisions, and standard claims handling practices. Notwithstanding, any alleged dispute between the parties has been resolved via an amicable resolution of the disputed claim in exchange for a full Release of Claims. Universal is pending receipt of the original executed Release by the Insured. Thus, it is Universal’s best understanding that the subject claim has been fully adjusted and resolved. Accordingly, the alleged statutory violations and factual allegations of wrongdoing set forth in the Notice are without merit. As previously noted, although the carrier strongly believes it has not been in violation of the Policy or law, circumstances giving rise to any alleged violation(s) have been corrected. We trust that the foregoing is sufficient to advise you of Universal’s position with regard to this matter and fully responds to the Notice. If there are any questions, please contact the undersigned. Sincerely, /s/ Ozzy Cudila Ozzy Cudila, Esq. Associate General Counsel
Acknowledgement
* The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.

Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.




DFS-10-363
Rev. 10/14/2008